Guest Eligibility Specialist II

Our Mission is to empower people on their journey to recovery, helping them achieve their goals, rediscover meaning and purpose in life, and reconnect with themselves and their communities. Our Vision is to revolutionize healthcare by pioneering innovative solutions that go beyond behavioral health, empowering people to thrive in the communities where they live, work, and play. Join a groundbreaking team at the forefront of Peer-Powered Support
, empowering individuals on their journey through mental health and substance use challenges! Be part of something bigger—together, we can change lives and create lasting hope!

Guest Eligibility Specialist II

Part-Time / Non-Exempt

Sunday, Monday, Thursday, and Friday 6:00 PM-10:00 PM

Crisis - Franklin County Crisis Care Center, Columbus, Ohio. This role is onsite.

$24.00 -$25.00/hour

Knowledge of OH Medicaid to include the OH Medicaid portal, authorizations, presumptive eligibility and Medicaid requirements

The Guest Eligibility Specialist II is responsible for managing the complete front-end eligibility and authorization process with greater independence, efficiency, and technical skill than the Specialist I. This includes verifying and entering guest information, reviewing clinical documentation using HCPCS, CPT, and ICD-10 codes, and initiating, submitting, and following up on authorizations through payer portals or fax. The role emphasizes advanced knowledge of coding, payer requirements, and problem-solving, while also contributing to workflow improvements and training initiatives.

This position is vital to ensuring guest information is processed accurately, efficiently, and in compliance with organizational and regulatory standards.

• Perform guest registration and authorization functions across multiple states.
• Reconcile insurance coverage discrepancies and ensure demographic accuracy.
• Validate complex eligibility situations, escalating only those requiring management review.
• Apply advanced knowledge of CPT, HCPCS, and ICD-10 coding when determining authorization needs.

• Ensure adherence to organizational compliance and payer requirements.
• Stay current with changes in state/federal regulations and payer guidelines.
• Identify trends and analyze payer issues, reporting findings to the Revenue Cycle Manager.
• Contribute to process improvements to enhance efficiency and reduce denials.

• Provide detailed documentation of authorization processes and payer communications.
• Communicate professionally with providers, payers, and internal departments, providing feedback and recommendations.
• Assist with developing SOPs and workflow documentation.
• Participate in training new staff members and mentoring peers.

• Independently manage prior authorizations, reauthorizations, and corrections.
• Research denial reasons with payers and recommend corrective actions to maximize reimbursement.
• Support appeals processes by submitting corrected authorizations as needed.
• Maintain detailed tracking of pending/resolved authorizations and payer issues.

As an innovative leader in behavioral health care, we are committed to supporting our teams through a comprehensive benefits package. This includes competitive health, dental, and vision insurance, as well as access to mental health resources and wellness programs. We offer a strong retirement plan with company matching and…